Jonsson, C., & Johansson, K. (2009). Pole walking for patients with breast cancer-related arm lymphedema. Physiotherapy Theory and Practice, 25(3), 165–173.

To investigate the influence of pole walking on arm lymphedema following breast cancer treatment when using a compression sleeve

Pole walking is a walking exercise with the addition of walking poles that simulates the arm motion of cross-country skiing during walking. Subjects participated in pole walking on one occasion for one hour outdoors in a park and on sidewalks for approximately 4 km. Each session was performed similarly and was supervised by the same person. Measurements were made before, immediately after, and 24 hours later.

• The study sample was comprised of female patients aged less than 70 years.
• Arm lymphedema was defined as the affected arm being 5% larger than the contralateral arm, including palpable thickness somewhere in the affected arm compared to the contralateral arm, and the patient's experience of tightness in the affected arm.
• The edema had to be persistent for at least six months.

The study took place at a single site in Sweden.

The study used a pre-post design.

• Both arms were measured with the water displacement method and the contralateral arm was used as a control on each occasion.
• Total arm volume was given in milliliters for both arms.
• Lymphedema absolute volume was calculated as the volume difference between the arms.
• The lymphedema relative volume was calculated in percentage.
• Subjective lymphedema assessments of experience of heaviness and tightness in the affected arm while standing with their arms hanging and no arm sleeve on were used.
• A 100-millimeter visual analog scale used the endpoints ‘‘no discomfort’’ (0 mm) and ‘‘worst imaginable\".

The patients showed no significant difference in total arm volume in the edema arm immediately after pole walking or 24 hours later compared to before walking. Immediately after pole walking, a significant decrease in lymphedema absolute volume and in lymphedema relative volume was found compared to before pole walking. Twenty-four hours later, no differences were found compared to before walking. There were no significant differences in rating of heaviness and tightness on the visual analog scale immediately after pole walking or after 24 hours compared to the rating before pole walking.

A controlled, short-duration pole-walking program can be performed by patients with arm lymphedema using a compression sleeve without deterioration of the arm lymphedema.

• The study had a small sample size (N < 30).
• Out of 42 candidates, 26 participated in the study.
• Participation bias should be advised.

Nurses and clinicians should be aware and encourage women with lymphedema to perform exercises, such as pole walking, which seems not to deteriorate arm lymphedema.